Month: November 2013

There has been tremendous growth in the field of dentistry over the past 100 years. In History of Dentistry Part 1, we examined dentistry in the years between 1900 and 1955. Now let’s take a look at dentistry from 1955 to the present.

Comfort in Dentistry

Patient comfort became a consideration when the first fully-reclining dental chair was introduced in 1958. Four-handed dentistry became popular in the U.S. shortly after. Dentists found that the technique improved productivity and shortened treatment time. On a side note, dental hygienists were permitted to wear pants in 1971, which made it possible for them to sit down while working on patients! However, it was not until the 1980s that hygienists stopped wearing caps as part of their uniforms.

New Treatment Developments

In 1957, the S. S. White company began producing the first clinically successful high-speed handpiece, the Borden Airotor, making it possible for teeth to be easily and quickly prepared. Today, high-speed handpieces operate at more than 300,000 rpms, which is faster than a jet engine.

Michael Buonocore, of Eastman Dental Center in Rochester, discovered bonding materials in 1955. These later led to a composite prototype used for restorations to this day.

Dental Hygiene in the Late 20th Century

The first commercial electric toothbrush was developed in Switzerland and introduced to the U.S. in 1960. That same year, Columbia University offered the first master’s degree in dental hygiene. The first male dental hygienist graduated from the University of New Mexico in 1965, when American Dental Association bylaws were amended to allow equality for male hygienists.

Another huge development was made in the 1960s, when lasers were developed and approved for soft tissue procedures. However, it would be over 30 years before the FDA approved the Erbium YAG laser, the first to be permitted for use on dentin, in the treatment of tooth decay.

The first commercial home teeth bleaching products appeared in 1989. In the following decade, new tooth-colored restorative materials ushered in an era of cosmetic dentistry.

Restorative Dentistry

As previously mentioned, Michael Buonocore, from Rochester’s Eastman Dental Center, first discovered bonding materials in 1955. In 1967, he introduced the composite prototype still used for restorations today. It consists of a plastic resin containing glass or quartz particles. Beginning in the late 1970s, composites became a key material in fillings, veneers, porcelain laminates, and the cementing of restorations.

Per-Invar Branemark developed the first dental implants in the 1960s, although they did not arrive in the U.S. until 1982. Implant placement is now the most commonly performed surgical procedure for dental patients.

The 21st Century

Dentistry in the 21st century hardly resembles dentistry 100 years ago. High-tech advances have transformed the way patients experience oral care. Alleviating dental anxiety among patients has become a  huge concern, leading to less-invasive implants and new uses for the lasers that first appeared in the second half of the 20th century.

Miniature dental implants can replace decayed or missing teeth for patients with limited bone in their jaws who have trouble holding in dentures.  Miniature implants don’t require the several month wait for bone to fuse, which is necessary with traditional implants. Instead, these implants can be placed in one visit without cutting into the gums.

The laser-assisted new attachment procedure (LANAP) makes it possible for dentists to treat infected gums without a scalpel. It uses a pulsing laser that can distinguish between healthy and diseased gums, leaving healthy tissue alone. Gums are also sealed with a thermal blood clot, which creates a physical barrier to bacteria.

With such dramatic changes already being made, it will be interesting to see what the next century holds for dentistry.

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The first decade of the 20th century was an exciting time. Electricity had paved the way for the vacuum cleaner and washing machine, making it easier to perform household chores. And electricity didn’t just simplify things at home, it also made it easier for dentists to do their jobs. For the first time, dentists could use power drills to treat cavities, paving the way for future technological advances over the next century. The field of dentistry grew rapidly over the next 100 years.

1900-1920

Two other innovations occurred during the early 1900s that affected the way dentists could treat patients. In 1903, Charles Land developed the porcelain jacket crown, which covered and protected the entire surface of a tooth. Then, in 1905, German chemist Alfred Einhorn was able to formulate a new local anesthetic called procraine, which took away the discomfort patients had to endure previously. Heinrich Braun brought the material to the U.S. in 1907, marketing it under the trade name most people are familiar with today – Novocaine.

With all of the changes taking place, a reference guide of techniques and procedures was needed. In 1908, Greene Vardiman Black, a leading reformer of American dentistry, published “Operative Dentistry.”  The monumental two-volume tome would become the essential clinical text for the next 50 years. Black later developed techniques for filling cavities, standardized dental operative procedures, and developed an improved amalgam.

The concept of dental hygiene was first introduced by Alfred C. Fones in 1913. He opened the first school in the world for dental hygienists in the city of Bridgeport, Connecticut, and became known as the “Father of Dental Hygiene.” There were 27 female students in the first graduating class, most of whom were later employed by the Bridgeport Board of Education to clean the teeth of the district’s school children.

1920-1940

It was during the 1920s that the Ritter Dental Company introduced the Model A Dental X-Ray, finally giving dentists an efficient diagnostic instrument. The machine needed two groups of transformers to adapt it to the various voltages and frequencies used during that time. Safety precautions also needed to be taken when the x-ray machine was in use. The clinician and patient both needed to stay at least one foot away from the high-voltage wire, which ran outside the arm from the transformer cabinet to the x-ray head.

The Ritter Company improved their x-ray machine in the 1930s, with the development of the Ritter Model B Shock Proof X-Ray. It eliminated earlier guesswork with an exact radiographic technique. It had a flexible x-ray head that was easy for dentists to adjust. Radiographs up to 14×17 inches were now possible.

Dental education evolved into a professional discipline during this period. In 1923, the American Association of Dental Schools was established. The following year, the American Dental Assistants Association was founded. Dental schools became university-based after the Carnegie Foundation issued the Gies Report, a comprehensive report that covered the state of dental education, in 1926. In 1928, the National Board of Examiners was established.

Research on fluoride was a major advancement in the 1930s. During that time, Frederick S. McKay, a Colorado dentist, determined that the brown stains on his patients’ teeth were related to the water supply. He conducted research from 1930-1943, verifying that drinking water with high levels of natural fluoride was associated with low dental caries yet high mottled enamel. By the beginning of the 1940s, H. Trendley Dean was able to establish the ideal fluoride level needed in drinking water to reduce decay without mottling. Grand Rapids, Michigan, was the first city in the world to fluoridate drinking water in 1945.

Dr. Alvin Strock inserted the first Vitallium dental screw implant in 1937, using the biocompatible implant metal developed by orthopedic surgeon Charles Venable a year prior. The nylon toothbrush, made of synthetic bristles, became available for purchase in 1938.

1940-1955

Swiss chemist Oskar Hagger developed the first system of bonding acrylic resin to dentin in 1949. The first fluoride toothpastes became available for purchase in the 1950s. In 1955, Michael Buonocore invented the first white (composite) fillings. He also described the acid etch technique for bonding resin to tooth enamel so that dentists could repair cracked enamel on front teeth.

Although big changes took place during the first half of the 20th century, even more advances were to come. Next time, we will look at the history of dentistry from 1950 to the present.

Just as there are certain foods that promote good oral health, there are foods that do not. These foods and drinks are best limited or avoided altogether. Some of the most harmful foods include:

Sugary foods. When you eat sugary foods, acids are produced in your mouth that cause tooth decay. Cakes, pies, and candies all include sugars that can harm your teeth.

Sticky sweets. Chewy sticky foods cling to your teeth, even after rinsing with water. Sugary gum and toffee are two to watch out for but even dried fruit can damage tooth enamel.

Acids. Foods high in acid, such as citrus fruits, tomatoes, and fruit juices, increase the acid levels in your mouth. There are even cereals and breads classified as acidic.

Junk Food. When you replace healthy foods with junk food, you do not get the vitamins and minerals your body needs to fight off infection. It may even make you more vulnerable to tooth decay.

Hard Candies. When you suck on mints, cough drops, and hard candies, it can have a demineralization effect on your teeth. They cause a concentrated build-up of acid.

Sports Drinks. Sweet, viscous liquids like sports drinks are acidic. In addition, they are thick liquids that can stick to your teeth for long periods of time.

Tips for Healthy Eating

With the holidays approaching it will become more difficult to avoid foods that are unhealthy because they will appear to be everywhere you look. Instead of depriving yourself, consider these tips:

When it comes to dessert, portion size is important. For example, go ahead and have a slice of cake. However, make it a small slice.

If you have a sticky dessert, try to eat it with your regular meal. That will balance out the potential damage to your tooth enamel.

Drink lots of water when you have a snack because it will help remove food and debris from your teeth. Also brush your teeth after eating a sugary dessert.

If you need a mint to freshen your breath after a meal, choose a sugar-free version. Gum that contains xylitol is another healthy option.

A Healthier Pumpkin Pie

One way to ensure that you don’t overdo it with unhealthy foods this holiday season is to bring a dessert you baked yourself. Here is a healthy take on pumpkin pie that won’t leave you feeling guilty.

Ingredients

Crust:

1 1/2 cups almond flour

3/4 cup pecans (crushed)

1/4 cup raisins

3 tbsps coconut oil

1/2 tsp salt

1/2 tsp salt

1/2 tsp ground cinnamon

1/4 cup applesauce (unsweetened)

1/4 tsp all-spice

1/4 tsp ginger

Filling:

2 cups pureed pumpkin

1 cup coconut milk

1/2 tsp salt

3 eggs

2 tsp cinnamon

1 tsp ground ginger

12 tsp ground nutmeg

1/4 tsp ground cloves

1/2 tsp lime zest

 

Crumble Topping:

1/4 cup pecans (crushed)

1/4 cup shredded coconut (unsweetened)

1/4 tsp ground cinnamon

2 tbsps raisins (chopped)

1 tbsp honey

Instructions

First prepare the crust.

Preheat the oven to 350 degrees F. In food processor, combine all ingredients until well-processed. Pour into a greased, deep, removable-bottom pie dish. Spread evenly with rubber spatula to form crust. Bake 10 minutes and remove from oven. Reshape if needed and set to the side.

Next prepare the filling.

Add all ingredients to food processor and mix until smooth creamy, about 60 to 90 seconds. Pour into pie crust. Bake for 35-40 minutes, or until filling is set. Remove from oven and cool for at least two hours. Then refrigerate overnight.

Finally, prepare the crumble topping.

Combine shredded coconut, raisins, pecans, salt, and cinnamon in food processor. Pulse several times until it resembles raw oatmeal. Add to small non-stick pan and toast 45-60 seconds over medium heat. Add honey and stir until melted. Place on a plate until cooled. Sprinkle on top of pie.

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When choosing foods that are good for your body, it is also important to choose foods that are good for your teeth. Certain foods protect your tooth enamel and keep your teeth free of debris. You also want to be careful not to sip drinks that expose your teeth to sugar. You should also take the preperation of food and allergens in manufacturing during the packaging of it. Some of the best foods for your teeth are:

Cheese/Chicken. These types of foods contain calcium and phosphorus.  Acids erode tooth enamel. When you eat foods such as cheese, chicken, nuts, and milk, the calcium and phosphorus is redeposited on your tooth enamel.

Crunchy Foods. Crisp vegetables and fruits contain a lot of water. The water dilutes the sugars inside them. It also stimulates saliva flow, which is important because it washes away food particles and acids which can harm your teeth.

Healthy Beverages. When you are thirsty, fluoridated water and milk are good choices. Fluoride is generally assumed to strengthen tooth enamel, preventing cavities and tooth loss. The calcium in milk strengthens teeth.

With Thanksgiving approaching, consider adding some dishes to your table that are healthy for your body and smile. Serve a bowls of nuts, raisins, dates, and figs. Arrange a platter of assorted cheeses along with sliced apples and grapes. Don’t forget crisp vegetables like broccoli and carrots.

Here are two suggestions for delicious and healthy foods to add to your table at the holidays.  They both contain ingredients that will help you and your family achieve and maintain a beautiful smile.

Pecan Crusted Chicken

This recipe is high in protein and has 0 grams of added sugars. It makes four servings and only takes about 30 minutes to prepare.

Ingredients:

• 4 boneless, skinless chicken breasts
• 1/2 cup pecan halves
• 1/4 cup plain dry breadcrumbs
• 2 tbsps water
• 1 tbsp canola oil, divided
• 1 1/2 tsps orange zest
• 1/2 tsp salt
• 1 large egg white

Starting with the first piece of chicken, place it between plastic wrap and pound it with a meat mallet until it is ¼ inch thick. Pulse pecans, breadcrumbs, orange zest, salt and ground chipotle in food processor until pecans finely ground. Pour into shallow dish. In a second shallow dish, blend egg white and water. Dip chicken into egg white mixture and then pecan mixture. Place on a plate while preparing the remaining pieces of chicken. Heat 1 tbsp canola oil in nonstick skillet set to medium heat. Place two chicken pieces in skillet and cook until outside is brown, approximately 3 minutes per side. Add remaining oil and cook the rest of the chicken. Serve promptly.

Asparagus Salad

Crisp, tender asparagus with a tasty dressing that serves 6. Less than 90 calories per serving.

• 1 lb. fresh asparagus
• 4 cups spring mix salad greens
• 1/3 cup balsamic vinegar
• 1/4 cup toasted almonds
• 2 tbsp orange juice
• 1 tbsp sesame seeds
• 2 tbsps water

Put asparagus and water into a microwave-safe baking dish (11x7x2). Cover dish and microwave 3 minutes on high or until crisp but tender. Drain and put asparagus in cold water. Drain and pat dry. On a serving platter, place salad greens and top with asparagus. Whisk vinegar, orange juice, and sesame seeds in small bowl. Drizzle dressing over salad and sprinkle almonds on top.

To learn more ways to build and maintain a healthy smile, see the cleanings and prevention section of Dr. Armstrong’s dental blog.

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Some patients are concerned about dental braces and the aesthetic effect of metalwork.  Invisalign is a fantastic option for straightening your teeth. It involves the use of clear plastic aligning trays made just for you. The custom-developed trays are switched out approximately every two weeks as your teeth move into position. An added benefit? The flexibility of being able to remove the trays makes it possible to remove Invisalign trays during important occasions.

Reasons for Seeking Invisalign Treatment

Invisalign trays are used to correct the same types of issues as traditional braces. However, the trays are invisible and can be removed whenever necessary. Some common issues that are treated with Invisalign are:

Gaps– Whether you have missing teeth or gaps caused by abnormal jaw growth, Invisalign can correct the problem.

Overcrowding– Invisalign trays can create spaces when there is not enough room in your mouth for all of your teeth to align, which increases your risk of tooth decay and may lead to gum disease.

Overbite– Correct an overlap between your upper and lower teeth for improved self-confidence, or to provide relief from jaw or TMJ discomfort.

Underbite– Ease jaw discomfort and improve the aesthetics of your smile by shifting lower teeth that overlap with your upper teeth.

Crossbite– Prevent the uneven wear that occurs when your bite meets in a crossbite, which can lead to bone erosion and gum disease.

Choosing Invisalign as a Treatment Option

Of course, these dental issues can be corrected with a variety of treatments, including traditional braces and porcelain veneers. However, many people find that Invisalign is the best treatment option to achieve the results they desire. For example, Invisalign trays actually straighten your teeth while veneers cover imperfections. Plus, the trays are comfortable and aesthetically pleasing, which makes it easy to keep them in.

The Invisalign Treatment Process

First your dentist will create an initial treatment plan. He will take pictures of your mouth with a special three-dimensional digital camera, and pull the photos up on a screen. Then your dentist can manipulate the teeth in the photos to get an idea of potential results. He can also observe your jaw from different angles. A unique set of aligning trays will be created based on the treatment plan your dentist develops. There are usually 20-29 aligners created per arch.

You may need several weeks to become comfortable with the Invisalign aligning trays. Even though they can be removed for special circumstances, it is important that you wear them at all other times. The one exception is when you are eating, because food can become trapped inside the trays.

Schedule an Office Visit

Ask your dentist if you have questions about whether Invisalign treatment is right for you or another other family member. School vacations are approaching, which makes it a great time to schedule appointments. Call right away, as appointments book up quickly at the end of the year.

The financial spending account (FSA) deadline is also coming up. Consider using your FSA balance to finance your trays instead of forfeiting your balance. You aren’t taxed on income placed in an FSA. If you plan on investigating Invisalign for you or a dependent for next year, schedule your FSA deductions now.

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November is American Diabetes Month. Raising awareness of this growing disease is an important part of reducing the instances of diabetes in the U.S. There are many issues surrounding diabetes and the people impacted by it.

According to the American Diabetes Association, there are over 26 million people with diabetes in the U.S. In addition, another 79 million people have prediabetes, which means they are at risk for developing type 2 diabetes. The cost of treating diagnosed diabetes in $245 billion in the U.S. alone.

Diabetes can damage many parts of the body if not managed. It can lead to:

• Heart attacks
• Stokes
• Amputation
• Blindness
• Kidney failure
• Nerve damage

Blood Glucose Levels

People with diabetes need to carefully monitor their blood glucose levels. Foods high in sugar, such as candy, cookies, and pies, will cause blood glucose to rise. These foods can also damage your teeth. Sugary foods, especially stick candies, sit on your teeth, exposing them the enamel to damaging acids. Sucrose has been proven to lower calcium, phosphorus, and fluoride on the teeth. In addition, when you fill your diet with sugary foods, you don’t eat as many healthy fruits and vegetables. There are certain crispy fruits and vegetables that actually protect your teeth from bacteria.

Diabetes and Gum Disease

People who have diabetes are also at a higher risk for dental problems, especially the development of gum disease. The high blood glucose levels associated with diabetes can cause gum disease to worsen quickly. Unfortunately having gum disease makes it harder to control blood glucose levels, creating a vicious circle. Dental issues associated with diabetes are not limited to gum disease. You are also prone to oral infections, thrush, and dry mouth.

It’s important to let your dentist know if you have diabetes. Inform your dentist of any medications you are taking. Do not have any non-emergency dental procedures while your blood sugar is not under control. You may not know that you have gum disease because symptoms are not always clear.

Seeing your dentist regularly will prevent gum disease, and also increase the chance that your gum disease will be diagnosed early. Catching gum disease in its early stage, called gingivitis can protect it from developing into periodontitis, which often requires surgery.

Recognizing Signs of Gum Disease

About 80 percent of all people will develop gum disease at some point.  It can develop at any age, although children and teens with diabetes are at a greater risk than those without diabetes. Some signs you can watch for include:

• Bad breath
• Bleeding gums
• Swollen, tender gums
• Loose teeth
• Changes in your bite
• Pus between teeth and gums

Importance of Dental Care

If you do have diabetes, one of the most important things you can do to prevent gum disease is to control your blood glucose level. Also see your dentist for an exam and cleaning at least once every six months. In the meantime, self-care is essential. Brush at least two minutes each day with an anti-gingival toothpaste accepted by the American Dental Association (ADA).

First, control your blood glucose level. Then take good care of your teeth and gums, along with regular dental check-ups every six months. Remember, you can prevent diabetes complications by properly managing blood glucose, blood pressure and cholesterol levels.  Eating a healthy diet, not smoking, and exercising regularly will also lower your risk of complications.

For more information about diabetes and your dental health, see “The Connection Between Diabetes and Your Oral Health.”

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As we discussed in the Craig Armstrong, DDS blog Don’t Lose Your Flexible Savings Account, this is the time of year when you must either use up the money in your FSA or lose it. In addition to all of the dental treatments you can finance with your FSA that were discussed in that blog post, there are other options available to you. Your FSA account can be used to pay for some types of dental health supplies, making it a great time of year to stock up on certain items.

First Aid. You are allowed to purchase first aid kits. as well as the items that are typically found in first aid kits, with your FSA. Pick up cold packs and compresses as well as gauze dressing to have on hand in case of emergency. Other things you may want to put in your first aid kit are temporary fillings, which come in handy while you are waiting to see the dentist, and peroxide.

Denture Care. Dentures can be paid for with money from your FSA. If you wear dentures, then you know how important it is to have denture adhesive available. You can also buy denture adhesives with your FSA funds.

Pain Relief. Products in the pain relief category require a prescription if you are going to use your FSA. These items include mouth pain relief such as Orajel and Anbesol. It also includes analgesics such as aspirin, acetaminophen, and ibuprofen.

Smoking Cessation. Smoking is one of the leading causes of oral cancers.  If you are a smoker, take time to quit now. Many smoking cessation products can be paid for with an FSA, although you may need a prescription. Items include Nicorette, Nicotrol, and nicotine replacement patches.

Preparing for Dental Care in 2014

This is also the time of year to consider your FSA needs for 2014. If your employer offers an FSA option, think about how much you want to set aside in 2014 to cover dental expenses.  Remember, your exam and teeth cleaning appointments are covered within FSA guidelines. In addition, do you think you will need:

• Orthodontia
• Extractions
• Implants
• Composite fillings

Perhaps you do not have dental coverage. In that case, check out healthcare.gov to find out what options are available to you under the Affordable Health Care Act. Dental coverage is offered as part of some health plans. The government website also has information about stand-alone plans which may meet your needs. There is an extensive excel spreadsheet on the website that identifies dental insurers by state, county, and program name. You do not need to register to get access to the spreadsheet. However, if you take a few minutes to register you can get more details relevant to your situation.

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If you have money taken out of your paycheck and placed in a flexible spending account (FSA), listen up. Any money that is left in your FSA after the deadline is lost for good. The deadline is December 31st but some employers give a two month and 15 day period for using up the money in your account. Fortunately, there are many ways to use the money in your FSA, and quite a few of them will help you maintain a beautiful smile! Covered dental expenses include procedures, such as teeth cleaning, fillings, and a whole lot more.

What is a Flexible Savings Account?

An FSA is a job-based plan that allows you to put in up to $2500 each year to be used for out-of-pocket health expenses. You do not have to pay taxes on the money in your FSA, which means you save some of your income. However, since you need to “use it or lose it,” it is very important that you estimate how much to put in the account. You should base your estimate on the money you spend on out-of-pocket expenses for co-payments, co-insurance, medications, and other allowed health care costs.

Which Dental Services Can Be Applied?

There are many options for using up your FSA account at the dentist’s office.

Preventative dental care. Your FSA can be used to pay for preventative care, such as teeth cleanings, fluoride treatments, and X-rays. You already know that you should see your dentist at least once every 6 months for a cleaning and exam. So if you need to empty your FSA account, consider scheduling your six month visit now.

If you aren’t due for your exam, schedule an extra visit anyway. It is a great way to get a head start on prevention. Besides, having your teeth cleaned will ensure that you have a beautiful smile for the holidays. It’s important to note that even though teeth cleanings are a covered expense, teeth whitening treatments are not. The IRS considers teeth whitening to be a cosmetic procedure.

Restorations. Use your FSA to restore your smile to where you have wanted it to be. Fill in unattractive spaces with dentures, partial dentures, or fixed bridges. Repair chipped or broken teeth with composite fillings. Relieve discomfort with an amalgam filling or root canal therapy. You will benefit by restoring chewing functionality and feeling better overall.

Oral Maxillofacial Surgery. There are several dental surgeries covered by your FSA. If you have been bothered by impacted wisdom teeth, finance their removal with your FSA. Other tooth extractions are also covered. If you need dental implant surgery, using your FSA is a great way to cut costs.

Orthodontia. Pay for orthodontia for yourself or your child with your FSA. The reimbursement procedure for orthodontia is slightly different than other reimbursements because the IRS recognizes it is an ongoing expense. Check with your dental office to find out about your options. Invisalign, an alternative to metal braces featuring clear aligners, is a covered expense.  You can even pay for a dental guard used to prevent teeth grinding.

If you are going to use your FSA to pay for dental work, be sure to make an appointment right away. Many other patients have the same idea, and those appointments get booked up quickly.

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